Wednesday, February 11, 2009

Important Health Care Lessons from Canada: Patients Stuck on Waiting Lists With Nowhere to Go

Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting.

Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance.In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan in January of 2006. Deciding that the wait was untenable, Mr. McCreith did what a lot of Canadians do: He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor.

Ontario's government system still refused to provide timely treatment, offering instead a months-long wait for surgery. In the end, Mr. McCreith returned to Buffalo and paid for surgery that may have saved his life. He's challenging Ontario's government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms.Canada's system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans can only hope that Barack Obama heeds the lessons that can be learned from Canadian hardships.~Nadeem Esmail in the WSJ

The problem with Canadian healthcare is not that people don't have to pay for treatment at the point of service, but that the system badly needs overhauling. To start with primary care physicians (family doctors)need to be paid more on a par with specialists, and some specialties (Internal medicine for one)also should be better paid. That way more medical students would chose to do their residencies in these areas. Also primary care should become a mix of professions working as a team, and should be funded according to the population they serve. Currently there is a lot of waste in the system as many FPs (many of those in walk-in-clinics for example) do not do full-sevice care, and doctors in general do many things that other professions could do better. Under the fee-for-service system most primary care practices cannot afford to pay other professionals.

But at least in Canada, despite the waits, no-one is driven into debt or unable to find care at all, or for their particular condition, as they are in the US.